Outbreak of acute renal failure in Panama in 2006: a case-control study.
OBJECTIVE
In September 2006, a Panamanian physician reported an unusual number of patients with unexplained acute renal failure frequently accompanied by severe neurological dysfunction. Twelve (57%) of 21 patients had died of the illness. This paper describes the investigation into the cause of the illness and the source of the outbreak.


METHODS
Case-control and laboratory investigations were implemented. Case patients (with acute renal failure of unknown etiology and serum creatinine > 2 mg/dl) were individually matched to hospitalized controls for age (+/- 5 years), sex and admission date (< 2 days before the case patient). Questionnaire and biological data were collected. The main outcome measure was the odds of ingesting prescription cough syrup in cases and controls.


RESULTS
Forty-two case patients and 140 control patients participated. The median age of cases was 68 years (range: 25-91 years); 64% were male. After controlling for pre-existing hypertension and renal disease and the use of angiotensin-converting enzyme inhibitors, a significant association was found between ingestion of prescription cough syrup and illness onset (adjusted odds ratio: 31.0, 95% confidence interval: 6.93-138). Laboratory analyses confirmed the presence of diethylene glycol (DEG) in biological samples from case patients, 8% DEG contamination in cough syrup samples and 22% contamination in the glycerin used to prepare the cough syrup.


CONCLUSIONS
The source of the outbreak was DEG-contaminated cough syrup. This investigation led to the recall of approximately 60 000 bottles of contaminated cough syrup, widespread screening of potentially exposed consumers and treatment of over 100 affected patients.
Rentz
E Danielle
ED
Centers for Disease Control and Prevention, Atlanta, GA, USA. erentz@cdc.gov
Lewis
Lauren
L
Mujica
Oscar J
OJ
Barr
Dana B
DB
Schier
Joshua G
JG
Weerasekera
Gayanga
G
Kuklenyik
Peter
P
McGeehin
Michael
M
Osterloh
John
J
Wamsley
Jacob
J
Lum
Washington
W
Alleyne
Camilo
C
Sosa
Nestor
N
Motta
Jorge
J
Rubin
Carol
C
D058186:Acute Kidney Injury / Q000139:chemically induced / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000996:Antitussive Agents / Q000032:analysis; D016022:Case-Control Studies; D004196:Disease Outbreaks; D004340:Drug Contamination; D005026:Ethylene Glycols / Q000032:analysis / Q000506:poisoning*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010176:Panama / Q000453:epidemiology; D055815:Young Adult
D000996:Antitussive Agents; D005026:Ethylene Glycols; C013484:diethylene glycol